| Background and objective:With the accelerated aging of the population and the extension of the average life expectancy,the incidence of stroke has gradually increased.Stroke has now risen to the second largest cause of death in humans.Its high incidence,high disability,high mortality and high recurrence rates have placed a heavy burden on families,societies and countries.70-80% of strokes are ischemic strokes.Intravenous thrombolytic therapy within 4.5 hours of onset has been shown to be safe and effective by numerous randomized clinical trials.However,there is insufficient clinical evidence for the efficacy of intravenous thrombolysis in different subgroups of stroke,especially in ischemic strokes with atrial fibrillation.intravenous thrombolysis in ischemic strokes with atrial fibrillation which is still controversial because of its unique clinical features and the different results of different studies.The purpose of this study was to investigate the safety and efficacy of intravenous thrombolytic therapy in ischemic stroke patients with atrial fibrillation,and to compare it with intravenous thrombolytic therapy for ischemic stroke without atrial fibrillation.Methods:From April 2015 to November 2017,a total of 1933 patients entered the stroke green channel in the First Hospital of Jilin University.Among them,546 patients received intravenous thrombolytic therapy or bridging therapy,and 500 patients received intravenous thrombolytic therapy alone.There were 65 patients with atrial fibrillation,435 patients without atrial fibrillation;32 patients with atrial fibrillation who received conventional antithrombotic therapy within 4.5 hours of onset.The study was divided into two parts: Part I:According to whether accompanied by atrial fibrillation,all patients receiving intravenous thrombolysis were divided into two groups: atrial fibrillation thrombolysis group,treated with intravenous thrombolysis and accompanied by atrial fibrillation,a total of 65 patients;Thrombolysis without atrial fibrillation group,thrombolytic therapy was performed in patients without atrial fibrillation and a total of 435 patients were included.Part II: According to whether or not receiving intravenous thrombolytic therapy,all patients with atrial fibrillation were divided into two groups: atrial fibrillation thrombolysis group,accompanied by atrial fibrillation and intravenous thrombolytic therapy,A total of 65 patients;atrial fibrillation non-thrombolysis group,accompanied by atrial fibrillation did not receive thrombolytic therapy,a total of 32 patients.Collected general data such as gender,age,past medical history,and admission blood pressure for all patients,and admitted and discharged National Institute of Health stroke scale(NIHSS).Follow-up 90 days modified Rankin scale(modified Rankin Scale,m RS).The differences in the favorable outcome,the incidence of hemorrhagic transformation and symptomatic intracranial hemorrhage,and the mortality between atrial fibrillation thrombolysis group and atrial fibrillation non-thrombolysis group and between atrial fibrillation thrombolysis group and thrombolysis without atrial fibrillation group were compared,and the factors associated with favorable outcome and mortality were analyzed by Logistic regression analysis.Results:65 patients in the atrial fibrillation thrombolysis group and 435 patients in the thrombolysis without atrial fibrillation group.In the baseline data of both groups,the proportion of male patients without atrial fibrillation was higher than that in the atrial fibrillation thrombolysis group(74.4% vs 56.9%,p=0.003),smoking and drinking history Higher than the atrial fibrillation thrombolysis group(smoking 62.3% vs 43.1%,p = 0.003;drinking 49.0% vs 30.8%,p = 0.006),the cases of hemorrhagic transformation in the atrial fibrillation thrombolysis group were significantly higher than those in the thrombolysis without atrial fibrillation group(32.3% vs16(3%,p=0.002);The proportion of symptomatic intracerebral hemorrhage was slightly higher in the atrial fibrillation thrombolysis group than in the thrombolysis without atrial fibrillation: symptomatic intracerebral hemorrhage occurred in 2 patients(3.1%)in the atrial fibrillation thrombolysis group and 8 cases in the thrombolysis without atrial fibrillation(1.8%)of patients developed symptomatic intracranial hemorrhage,but statistical differences between the two did not reach.Three-month mortality was significantly higher in the atrial fibrillation thrombolysis group than in the thrombolysis without atrial fibrillation(21.5% vs 6.9%,p<0.001).Logistic regression analysis showed that AF(OR 4.233,95% CI 1.909-9.386,p<0.001),symptomatic intracranial hemorrhage(OR 35.490,95% CI 6.576-191.538,p<0.001),baseline NIHSS score(1.108,95%CI 1.065-1.152,p<0.001)and age(OR 1.047,95% CI 1.010-1.084,p=0.012)were independent risk factors for death.The atrial fibrillation thrombolysis group included 65 patients and 32 atrial fibrillation non-thrombolysis group.There was no statistically significant difference in baseline data between the two groups.There were 30 cases(46.2%)with favorable outcome in the atrial fibrillation thrombolysis group,Seven patients(21.9%)had a good prognosis in the atrial fibrillation non-thrombolysis group.There was a statistically significant difference between the two groups(p=0.021).The incidence of hemorrhagic transformation in the two groups was 32.3% and 7.3%,statistically significant difference(p=0.005),but the proportion of symptomatic intracranial hemorrhage in the two groups were 3.1% and 3.0%,respectively,there was no statistical difference between the two groups(p=0.990);within the atrial fibrillation thrombolysis group within 90 days 14 cases(21.5%)patients died,6 patients in theatrial fibrillation non-thrombolysis group died(18.8%),no significant difference in mortality(p=0.750).Logistic regression analysis showed that thrombolytic therapy(OR 3.309,95% CI 1.152-9.505)and a lower baseline NIHSS score(OR 0.846,95% CI 0.772-0.927)were favorable prognostic factors.65 patients in the atrial fibrillation thrombolysis group and 435 patients in the thrombolysis without atrial fibrillation group.In the baseline data of both groups,the proportion of male patients without atrial fibrillation was higher than that in the atrial fibrillation thrombolysis group(74.4% vs 56.9%,p=0.003),smoking and drinking history Higher than the atrial fibrillation thrombolysis group(smoking 62.3% vs 43.1%,p = 0.003;drinking 49.0% vs 30.8%,p = 0.006),the cases of hemorrhagic transformation in the atrial fibrillation thrombolysis group were significantly higher than those in the thrombolysis without atrial fibrillation group(32.3% vs16(3%,p=0.002);The proportion of symptomatic intracerebral hemorrhage was slightly higher in the atrial fibrillation thrombolysis group than in the thrombolysis without atrial fibrillation: symptomatic intracerebral hemorrhage occurred in 2 patients(3.1%)in the atrial fibrillation thrombolysis group and 8 cases in the thrombolysis without atrial fibrillation(1.8%)of patients developed symptomatic intracranial hemorrhage,but statistical differences between the two did not reach.Three-month mortality was significantly higher in the atrial fibrillation thrombolysis group than in the thrombolysis without atrial fibrillation(21.5% vs 6.9%,p<0.001).Logistic regression analysis showed that AF(OR 4.233,95% CI 1.909-9.386,p<0.001),symptomatic intracranial hemorrhage(OR 35.490,95% CI 6.576-191.538,p<0.001),baseline NIHSS score(1.108,95%CI 1.065-1.152,p<0.001)and age(OR 1.047,95% CI 1.010-1.084,p=0.012)were independent risk factors for death.Conclusions:(1)Compared with ischemic stroke patients without AF,there was no significant difference in the rate of good prognosis after intravenous thrombolysis in patients with atrial fibrillation,but mortality was higher after 90 days;(2)Atrial fibrillation,symptomatic intracranial hemorrhage,higher baseline NIHSS score,and advanced age were independent risk factors for death;(3)For patients with acute ischemic stroke with atrial fibrillation,intravenous thrombolytic therapy is superior to conventional antithrombotic therapy;(4)thrombolytic therapy and admission/baseline NIHSS score are good protective factors for good prognosis. |
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